Sengupta Tamal Kanti, Prakash Gautam, Ray Saugata, Kar Manoranjan
Department of General Surgery, Midnapore Medical College, West Midnapore, West Bengal, India.
Niger Med J. 2020 Nov-Dec;61(6):328-333. doi: 10.4103/nmj.NMJ_191_20. Epub 2020 Dec 19.
The purpose of this study is to estimate disease burden, clinical features, and outcome in the emergency surgical management of peptic perforation in a rural government tertiary care center where patients are socioeconomically very poor and also impacted by lack of good quality health-care facility.
The study had retrospectively analyzed 121 patients with peptic perforation who had undergone emergency laparotomy at Midnapore medical college, West Bengal, India, from June 2018 to December 2019. All patients >12 years were included in this study. Exclusion criteria were other traumatic and nontraumatic gastrointestinal perforations.
The study population had 112 males and 9 females with a mean age of 44.80 ± 15.29 years and maximum incidence in the 6 decade ( = 0.001). Smoking and alcohol were associated with 54.5% and 49.6%, respectively. The symptoms were pain abdomen (100%) with vomiting (38.8%) and fever (33.9%). The signs of hypotension, peritonitis, distension, and pneumoperitoneum were observed in 34.7%, 64.5%, 39.7%, and 83.5%, respectively. Only 20.7% of patients were admitted within the first 24 h. The mean duration of symptoms was 2.3 days. Most perforations were located on the duodenum (74.4%) with duodenal to gastric perforation ratio 2.9:1. The mean size was 1.02 cm. Chest infection (19%) was the most common complication. The mortality rate was 9.1%. The mean length of hospital stay was 11.1 days.
Peptic perforation remains a major disease burden in our environment predominantly due to late presentation, leading to high morbidity and mortality.
本研究旨在评估在一个农村政府三级护理中心，对消化性穿孔进行急诊手术治疗时的疾病负担、临床特征及治疗结果。该中心的患者社会经济状况极差，且缺乏优质的医疗保健设施。
本研究回顾性分析了2018年6月至2019年12月期间，在印度西孟加拉邦米德纳布尔医学院接受急诊剖腹手术的121例消化性穿孔患者。所有年龄大于12岁的患者均纳入本研究。排除标准为其他创伤性和非创伤性胃肠道穿孔。
研究人群包括112例男性和9例女性，平均年龄为44.80±15.29岁，60岁年龄段发病率最高（P = 0.001）。吸烟和饮酒的关联率分别为54.5%和49.6%。症状包括腹痛（100%）、呕吐（38.8%）和发热（33.9%）。低血压、腹膜炎、腹胀和气腹的体征分别在34.7%、64.5%、39.7%和83.5%的患者中观察到。仅20.7%的患者在发病后24小时内入院。症状的平均持续时间为2.3天。大多数穿孔位于十二指肠（74.4%），十二指肠穿孔与胃穿孔的比例为2.9:1。平均穿孔大小为1.02厘米。肺部感染（19%）是最常见的并发症。死亡率为9.1%。平均住院时间为11.1天。
在我们所处的环境中，消化性穿孔仍然是一个主要的疾病负担，主要原因是就诊延迟，导致高发病率和死亡率。
